How a Gynaecological Cancer Starts, and What Your Body May Show You

Why talk about gynaecological cancer symptoms this September?

September is often used internationally as a moment to talk about cancers of the female reproductive system. At EC Clinic in Dublin we use that calendar as a prompt for education — not as a claim that Ireland has designated a national gynaecological cancer awareness month.

The aim is practical: help you understand the five main gynaecological cancers, which symptoms deserve assessment, and which tests answer which questions — from information and body awareness, not from fear.

What is gynaecological cancer, really?

Gynaecological cancer is not one disease. It is an umbrella term for cancers that affect the female reproductive system: womb (endometrial), ovarian and fallopian-tube, cervical, vaginal and vulval cancers.

These cancers can affect anyone who has a womb, ovaries and fallopian tubes, a cervix, vagina or vulva. That includes women, transgender men and people assigned female at birth who retain these organs.

At EC Clinic, assessment usually begins with a general gynaecological consultation, with ultrasound of the uterus and ovaries available in the same clinical pathway when indicated.

What actually has to happen for a normal cell to become cancerous?

A normal cell is not free to grow forever. It receives chemical signals that tell it when to divide, when to repair itself and when to die. Cancer develops when a cell accumulates enough changes in the genes and signalling systems that control those rules.

Some of those changes occur simply because cells have been dividing for decades. Others are associated with inherited susceptibility, chronic infection, hormonal environments, inflammation or exposure to carcinogens. Often there is no single event that can be blamed.

The important part for a patient is this: cancer usually develops through a biological process over time. A stressful month, a missed vitamin or one “bad” lifestyle choice does not suddenly create a tumour.

A symptom appears when abnormal tissue starts changing the behaviour of an organ. That symptom may still have a benign cause. Bleeding can come from a polyp. Bloating can come from the bowel. Vulval itching can come from dermatitis. This is why I never want a woman to diagnose herself from a symptom list.

What makes a symptom useful clinically is its pattern:

• Is it new?
• Is it persistent rather than occasional?
• Is it getting more frequent or more intense?
• Is it happening after menopause?
• Is it clearly different from your normal cycle or digestive pattern?
• Is there a visible or palpable change?

That is the information that helps us decide what to investigate.

How does cervical cancer start, and does HPV mean I have cancer?

No. HPV does not mean cancer.

Human papillomavirus is one of the most common sexually transmitted viruses. Most sexually active adults are exposed to it at some point, and most infections are cleared or suppressed by the immune system without ever causing cancer.

The concern is persistent infection with certain high-risk HPV types. When high-risk HPV remains in cervical cells over time, viral proteins can interfere with the cell’s normal control mechanisms. Some cells may then become abnormal. These changes can pass through precancerous stages before an invasive cervical cancer develops.

That long precancerous phase is precisely why cervical screening works. Screening is not waiting for cancer to appear. It is looking for risk and cellular change early enough to interrupt the process. In Ireland that pathway is CervicalCheck; privately, EC Clinic also offers a private cervical check pathway when clinically appropriate.

Possible cervical symptoms include:

• bleeding after sex
• new unexplained bleeding between periods
• unusual persistent vaginal discharge
• pelvic pain in some cases

But early cervical changes can cause no symptoms at all. That is why “I feel fine” and “my screening is up to date” are two different but complementary pieces of information.

Why is bleeding after menopause one of the symptoms doctors take seriously?

Because after menopause, vaginal bleeding is no longer part of a normal menstrual cycle.

The endometrium is the lining inside the uterus. Before menopause, it grows and sheds in response to hormones. Endometrial cancer, often called womb cancer, begins when cells in that lining grow abnormally and become malignant.

One reason endometrial cancer can sometimes be identified relatively early is that the lining often announces a problem through unexpected bleeding.

That does not mean postmenopausal bleeding equals cancer. Most episodes have benign explanations, including thinning of the vaginal or endometrial tissues, polyps and other non-cancerous causes. But because endometrial cancer is one of the conditions we need to exclude, the correct response is investigation rather than reassurance by assumption.

A typical assessment may include:

• a detailed bleeding history
• pelvic examination
• transvaginal ultrasound to assess the uterus and endometrial lining
• endometrial sampling or biopsy when clinically indicated

A biopsy simply means taking a small tissue sample and asking a pathologist to examine the cells under a microscope.

Where does ovarian cancer actually start?

“Ovarian cancer” is a broad name for several biologically different cancers. One of the most important changes in modern gynaecological oncology has been the recognition that many high-grade serous carcinomas — the common aggressive epithelial type — probably begin in the fimbrial end of the fallopian tube before involving the ovary.

You do not need to remember the pathology terminology. The reason it matters is that it explains why ovarian/fallopian-tube cancer behaves differently from cervical cancer and why it is more difficult to screen for.

The HSE is explicit: there is no screening test for ovarian cancer in the general population. See the HSE pages on ovarian cancer symptoms and diagnosis.

Symptoms can also overlap with common digestive or urinary problems. The HSE lists persistent bloating, eating problems or feeling full more quickly, abdominal or pelvic pain, and urinary or bowel changes among the symptoms to check.

The word I emphasise is persistent.

Everyone feels bloated occasionally. A useful clinical pattern is bloating that is new, frequent and does not simply come and go as it used to. The same applies to early satiety — feeling full unusually quickly — or a new urinary pattern.

If symptoms continue despite an initially reassuring test, they deserve review. One normal result does not automatically explain a persistent symptom.

Is CA125 an ovarian cancer test?

CA125 is a blood marker that may be elevated in ovarian cancer, but it is not a yes/no cancer test.

It can also be raised by benign conditions such as endometriosis, fibroids and pregnancy. Conversely, CA125 can be normal in some early ovarian cancers.

This is a useful example of a principle I teach constantly: a test only makes sense in the clinical question it was designed to answer.

If symptoms suggest ovarian pathology, assessment may involve examination, CA125 in appropriate circumstances, pelvic ultrasound and referral for further imaging or specialist review depending on the findings.

What symptoms can come from vulval cancer?

The vulva is the external genital area. Vulval cancers can develop through HPV-related pathways or through non-HPV pathways, including chronic vulval skin disease.

Symptoms that deserve examination include:

• a persistent lump or thickened area
• an ulcer that does not heal
• persistent itching or soreness
• a patch of skin that changes colour or texture
• unexplained pain or bleeding

The difficulty here is not usually access to a sophisticated test. Often it is that the patient has waited months because the symptom felt embarrassing, or because she assumed a skin change was “just irritation.”

A proper visual examination is one of the most useful first steps.

And vaginal cancer?

Primary vaginal cancer is rare. Symptoms can include unexplained vaginal bleeding, unusual discharge, pain or a lump.

Again, these symptoms are not specific to cancer. But persistent change is a reason to examine the tissue rather than guess.

Can a normal cervical screening result rule out all gynaecological cancers?

No, and this is one of the most important misunderstandings I see.

CervicalCheck is a cervical cancer prevention programme. It assesses high-risk HPV and cervical risk according to the Irish screening pathway. Details are on cervicalcheck.ie.

It does not screen:

• the ovaries
• fallopian tubes
• endometrium or womb lining
• vulva
• vagina

So a woman can quite correctly say, “My cervical screen was normal,” and still need assessment for postmenopausal bleeding or persistent bloating. The screen is not wrong. It is answering a different question.

What happens if a gynaecologist finds something suspicious?

The first job is to locate the likely source of the problem. Then we choose the test that can answer that specific question.

A safe diagnostic pathway may look like this:

History → examination → targeted imaging/testing → biopsy or tissue diagnosis if needed → specialist referral → staging and treatment planning if cancer is confirmed.

“Staging” means determining how far a cancer has spread. Treatment then depends on the cancer type and stage and can include surgery, radiotherapy, systemic therapy or combinations of these.

EC Clinic is not an oncology treatment centre. Its role is to recognise symptoms, perform appropriate gynaecological assessment, arrange or recommend relevant investigations and refer into specialist pathways when a cancer is suspected.

That distinction matters. Good medicine is not pretending one clinic does everything. It is getting the patient to the right level of care efficiently.

When should I book rather than wait and see?

I would want you to arrange assessment for:

• any bleeding after menopause
• repeated bleeding after sex
• new unexplained bleeding between periods
• persistent bloating, early fullness or pelvic/abdominal pain
• a new urinary or bowel pattern that persists
• a persistent vulval lump, ulcer, itch, colour change or texture change
• any symptom that is clearly worsening or different from your baseline

Heavy uncontrolled bleeding, fainting, severe acute pain or significant illness needs urgent medical assessment rather than a routine appointment.

Why does family history change the conversation?

A family history of ovarian or breast cancer can sometimes indicate an inherited susceptibility such as a BRCA-related syndrome, although most cancers are not caused by an inherited mutation.

What matters is the pattern: which relatives were affected, which cancers they had, whether they were on the same side of the family, and how young they were at diagnosis.

Do not reduce family history to “yes/no.” Bring the details you know. They may change whether genetic counselling is appropriate.

Medically reviewed by Dr. Eliana Castañeda, Obstetrician-Gynaecologist and Aesthetic Specialist · 1 September 2026

— Dr. Eliana Castañeda
Obstetrician-Gynaecologist and Aesthetic Specialist · Medical Director, EC Clinic Dublin